Cholangioscopy is a minimally invasive endoscopic method used both for direct visual diagnostic evaluation of and for therapeutic intervention in the bile ducts. Peroral cholangioscopy overcomes some of the limitations of endoscopic retrograde cholangiopancreatography (ERCP) alone, although the procedures may be done together. Pancreatoscopy is the direct visual evaluation of the pancreatic ducts.
Although it has been in limited use since the 1950s, cholangioscopy has recently become more practically feasible, due in part to advances in endoscopic technique, scope design/materials, and functionality. However, cholangioscopes (and related smaller endoscopes that are dimensioned to be operated through a working channel of standard gastric endoscope, duodenoscope or the like, as well as within the bile ducts of a human patient, referred to as “miniscopes” or “baby scopes” where the larger scope is a “mother scope”) have several limitations. For example, certain models require two endoscopists (see, e.g., FIG. 1A, where a first endoscopist 102 operates the “mother scope” 110, and a second endoscopist 104 operates the “baby scope” 140). This significantly increases the cost of procedures and complicates the logistics in smaller operating suites.
As shown in FIG. 1B, other miniscope models, although designed for use by a single endoscopist, may have control surfaces 142 for steering/manipulating and operating the miniscope 140 disposed offset at a significant distance from the control surfaces 112 of the larger endoscope 110 through which the miniscope 140 is situated. Those of skill in the art will appreciate that this can be uncomfortable for the user/endoscopist, as the position of the miniscope controls 142 is a significant distance away from the mechanical center of stability of the two-scope system, which center of stability is necessarily created by the endoscopist's left hand.
As a consequence, with this type of miniscope, forces impacting upon the system due to manipulation of the miniscope controls (and port features) create significant torsional moments about the center of stability at the endoscopist's left hand. This is due to the long moment arm through which these forces act. These torsional moments must be resisted by the left hand of the endoscopist, and can create difficulty with control as well as operator fatigue. In addition, the strap-mounting structure 143 used for mounting such a miniscope 140 below the mother scope's accessory channel 114 leaves a prominent gap 141a between the two endoscopes' control surfaces, as well a prominent cross-hatched gap region 141b between the two endoscopes bodies, which (due in part to the relative body lengths compared to the length of attachment region) can create an unstable coupling, such that—under the typical forces of manipulation—this type of miniscope may rock, shift, slip downwards, or pivot about the primary axis of the larger “mother scope” (e.g., duodenoscope). These movements can create additional difficulty, stress, and fatigue for the endoscopist, which can have a negative impact.
Cholangioscopy is known to be an effective diagnostic and therapeutic tool, and there is a need for providing a miniscope that addresses needs in the existing art while providing technology that is diagnostically effective, therapeutically effective, and cost-effective. It may be desirable to provide a miniscope, configured for use in cholangioscopy or other dual-endoscope procedures that provides a secure, rigid mounting of two scopes together, with control surfaces provided and located to promote ease of efficient operation.